From the Guidelines
Scarlet fever should be treated with penicillin as the first-line antibiotic due to its proven efficacy, safety, and low cost, as recommended by the Infectious Diseases Society of America 1. The treatment for scarlet fever involves administering antibiotics to eradicate the infecting Group A Streptococcus organism from the pharynx.
- The preferred antibiotic is penicillin, which can be given orally for 10 days or as an intramuscular injection of benzathine penicillin G for patients who may not complete the full oral course.
- For patients allergic to penicillin, alternative antibiotics such as erythromycin, first- or second-generation cephalosporins, macrolides, or clindamycin can be used, as stated in the guideline by the Infectious Diseases Society of America 1.
- The dosage and duration of the antibiotic therapy should be sufficient to eradicate the infecting organism from the pharynx, typically 10 days for oral antibiotics.
- Supportive care, including rest, increased fluid intake, and management of symptoms like fever and discomfort with acetaminophen or ibuprofen, is also essential for patient recovery.
- It is crucial to complete the full course of antibiotics to prevent complications and recurrence, and the patient should be isolated for 24 hours after starting antibiotics to prevent spreading the infection.
From the FDA Drug Label
It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever.
The treatment for scarlet fever, which is caused by Streptococcus pyogenes, is amoxicillin for at least 10 days to prevent the occurrence of acute rheumatic fever 2.
- The recommended dosage for adults and pediatric patients aged 3 months and older is as follows: + Ear/Nose/Throat: 500 mg every 12 hours or 250 mg every 8 hours for mild/moderate infections, and 875 mg every 12 hours or 500 mg every 8 hours for severe infections. + Skin/Skin Structure: 500 mg every 12 hours or 250 mg every 8 hours for mild/moderate infections, and 875 mg every 12 hours or 500 mg every 8 hours for severe infections.
- For pediatric patients aged less than 12 weeks, the recommended upper dose of amoxicillin is 30 mg/kg/day divided every 12 hours 2.
- Azithromycin can be used as an alternative to first-line therapy in individuals who cannot use first-line therapy for pharyngitis/tonsillitis caused by Streptococcus pyogenes 3.
From the Research
Treatment Options
- The treatment for scarlet fever typically involves the use of antibiotics to speed recovery, reduce the length of time the infection is contagious, and reduce the risk of complications 4.
- National guidance recommends treating people with scarlet fever with antibiotics regardless of the severity of illness 4.
Antibiotic Resistance
- Studies have shown that group A Streptococcus (GAS) isolates are sensitive to penicillin, ceftriaxone, and vancomycin, but highly resistant to erythromycin and clindamycin 5.
- Penicillin is considered the antibiotic of choice for GAS infections, including scarlet fever 5.